РусскийWhat are Medicare Supplement plans
Medicare Supplement plans, also known as Medigap, are insurance policies designed to fill the gaps left by Original Medicare (Parts A and B). While Original Medicare covers a significant portion of healthcare expenses, it doesn’t cover everything. Costs like copayments, coinsurance, and deductibles can add up quickly, and that’s where Medigap plans come in. These private insurance plans help cover some of these additional costs, offering more predictable out-of-pocket expenses for beneficiaries.
In this guide, we’ll explore what Medigap plans are, what they cover, how to enroll, and other critical considerations for choosing the right Medigap policy.
Why Medigap Plans Are Important
While Original Medicare offers comprehensive coverage, it doesn’t cap out-of-pocket costs, meaning you could face substantial expenses for hospital stays, skilled nursing care, and other medical services. A Medigap plan helps mitigate these costs, making healthcare more predictable and manageable.
For example, Original Medicare requires beneficiaries to pay a deductible for each hospital stay under Part A, as well as 20% of the cost of most outpatient services under Part B. Medigap plans can cover these costs, giving policyholders peace of mind when it comes to unpredictable medical bills.
What Medigap Plans Cover
Medigap policies are standardized across most states (with exceptions like Massachusetts, Minnesota, and Wisconsin). The federal government mandates that all Medigap plans must provide the same core benefits regardless of the insurance company offering them. This standardization helps consumers compare different plans more easily.
There are currently 10 different Medigap plan types, labeled Plans A, B, C, D, F, G, K, L, M, and N. Each offers a different level of coverage. Here’s a breakdown of the common benefits covered by these plans:
- Part A Coinsurance & Hospital Costs:
- All Medigap plans cover coinsurance and hospital costs for up to an additional 365 days after Original Medicare benefits are used up.
- Part B Coinsurance or Copayments:
- Plans generally cover the 20% coinsurance for outpatient care under Medicare Part B.
- Blood (First 3 Pints):
- Medigap plans cover the cost of the first three pints of blood used in a medical procedure.
- Part A Hospice Care Coinsurance or Copayments:
- Medigap covers any copayments or coinsurance required for hospice care under Medicare Part A.
- Skilled Nursing Facility Care Coinsurance:
- Some plans, such as Plan G and Plan F, provide coverage for the daily coinsurance for skilled nursing facilities after Medicare Part A benefits are used up.
- Part A and Part B Deductibles:
- Plan F and Plan C cover both the Part A and Part B deductibles (although Plan C and Plan F are only available to individuals who were eligible for Medicare before January 1, 2020).
- Foreign Travel Emergency Coverage:
- Some Medigap plans offer limited coverage for medical emergencies while traveling abroad (up to 80% of approved costs, after meeting a deductible).
- Excess Charges:
- Some plans (like Plan F and Plan G) cover excess charges that healthcare providers may charge over what Medicare allows for a service.
Medigap Plan Chart (2024)
Here is a simplified chart summarizing what the various Medigap plans cover:
|
Benefit |
A |
B |
C |
D |
F* |
G |
K |
L |
M |
N |
|---|---|---|---|---|---|---|---|---|---|---|
|
Part A Coinsurance and Hospital Costs |
100% |
100% |
100% |
100% |
100% |
100% |
100% |
100% |
100% |
100% |
|
Part B Coinsurance or Copayment |
100% |
100% |
100% |
100% |
100% |
100% |
50% |
75% |
100% |
100% |
|
Blood (First 3 Pints) |
100% |
100% |
100% |
100% |
100% |
100% |
50% |
75% |
100% |
100% |
|
Part A Hospice Care Coinsurance/Copayment |
100% |
100% |
100% |
100% |
100% |
100% |
50% |
75% |
100% |
100% |
|
Skilled Nursing Facility Care Coinsurance |
100% |
100% |
100% |
100% |
50% |
75% |
100% |
100% |
||
|
Part A Deductible |
100% |
100% |
100% |
100% |
100% |
50% |
75% |
50% |
100% |
|
|
Part B Deductible |
100% |
100% |
||||||||
|
Part B Excess Charges |
100% |
100% |
||||||||
|
Foreign Travel Emergency |
80% |
80% |
80% |
80% |
80% |
80% |
*Note: Plan F is no longer available to new enrollees as of January 1, 2020, but those who already have Plan F may keep it.
Medigap Enrollment and Eligibility
You are eligible to enroll in a Medigap plan if you are already enrolled in Medicare Part A and Part B. The best time to sign up for a Medigap plan is during your Medigap Open Enrollment Period, which is a six-month period that begins the first month you’re 65 or older and enrolled in Part B. During this time, you can purchase any Medigap policy available in your area without undergoing medical underwriting or paying higher premiums due to health conditions.
If you miss this enrollment window, you may still be able to purchase a Medigap plan later, but insurance companies can charge higher premiums or deny coverage based on your health status.
Medigap vs Medicare Advantage
It’s important to understand that Medigap plans are different from Medicare Advantage plans (Part C). While Medicare Advantage plans are an alternative to Original Medicare and often bundle additional benefits like vision or dental coverage, Medigap plans only work in conjunction with Original Medicare. You cannot have both a Medicare Advantage plan and a Medigap plan at the same time.
|
Feature |
Medigap Plan (Medicare Supplement) |
Medicare Advantage (Part C) |
|---|---|---|
|
Works with Original Medicare |
Yes |
No (it replaces Original Medicare) |
|
Networks |
Any provider that accepts Medicare |
Often requires in-network providers |
|
Premiums |
Additional premium beyond Medicare Part B |
Typically lower premiums, with more cost-sharing |
|
Additional Benefits (e.g., dental) |
No |
Yes, often includes extra benefits |
|
Travel Coverage |
Some plans offer foreign travel coverage |
Usually limited to emergency care only |
Costs of Medigap Plans
Medigap plans come with their own monthly premiums in addition to the premiums you already pay for Medicare Part B. These premiums vary based on several factors:
- Plan Type: More comprehensive plans like Plan F or Plan G typically cost more than basic plans like Plan A.
- Location: Premiums can differ significantly depending on your state or even your zip code.
- Age and Health: While you can’t be denied coverage during your open enrollment, signing up later can result in higher premiums based on your age or medical history.
Key Considerations When Choosing a Medigap Plan
- Budget: Consider how much you’re willing to spend on premiums versus how much coverage you want for out-of-pocket expenses.
- Health Needs: Evaluate your current and anticipated health care needs. For example, if you see doctors frequently, you may benefit from a plan that covers Part B coinsurance.
- Future Travel: If you plan to travel abroad, a plan with foreign travel emergency coverage may be beneficial.
- Provider Choice: Medigap gives you the flexibility to see any doctor or specialist that accepts Medicare, which may be important if you prefer more provider choices.
How to Compare and Enroll in Medigap Plans
- Research Plans: Review and compare Medigap policies available in your area. Use online tools like Medicare.gov or work with an insurance broker.
- Check Costs: Look at the premiums and compare them against the benefits you’ll receive. Some companies may offer discounts, for example, if you pay annually instead of monthly.
- Enroll: After choosing the right plan, you can enroll directly with the insurance company offering the Medigap policy. Keep in mind that Medigap plans are only available through private insurers.
Conclusion
Medigap plans are a valuable option for those who want more predictability in their healthcare costs and want to minimize out-of-pocket expenses not covered by Original Medicare. With different levels of coverage, choosing the right Medigap plan can offer peace of mind and financial protection as you navigate your healthcare journey.
Consider your health needs, financial situation, and future plans when selecting a Medigap plan, and don’t hesitate to seek professional advice if you need help deciding which option is best for you.
If you need no-cost assistance from licensed Medicare brokers, feel free to contact us at 616-600-8444, and we will be happy to help.
For more information:
Medicare vs Medicaid
Medicare Eligibility
How to compare Medigap policies